Comparison of the Effectiveness of Schema Therapy and Compassion-Focused Therapy (CFT) on Self-blame and Distress Tolerance in People Living with HIV (PLWH)

Abstract

Background: Human immunodeficiency virus (HIV) continues to represent a major global health challenge, exerting profound physical, social, and psychological effects. In addition to its biomedical implications, HIV infection is frequently accompanied by elevated levels of self-blame, internalized stigma, and reduced distress tolerance, all of which contribute to significant psychological morbidity. Addressing these mental health concerns is therefore critical to improving overall quality of life and treatment adherence among individuals living with HIV. Objectives: The present study seeks to evaluate the relative efficacy of two evidence-informed therapeutic modalities: Schema therapy (ST) and compassion-focused therapy (CFT) in mitigating these psychological difficulties. Methods: This study utilized a randomized controlled trial (RCT) design with three assessment points: Pre-test, post-test, and a three-month follow-up. A total of 60 individuals living with HIV, registered at the Behavioral Disease Counseling Center of Imam Khomeini Hospital in Tehran, were recruited through purposive sampling and subsequently randomized into three groups (n = 20 per group): ST, CFT, and a control group. The intervention groups received eight group-based therapy sessions, each lasting 90 minutes, conducted in accordance with the established protocols for their respective approaches. The control group did not receive any psychological intervention during the study period. Data collection instruments included the Self-blame Scale (Thompson and Zuroff) and the Distress Tolerance Scale (DTS, Simons and Gaher). Data were analyzed using mixed-design repeated measures analysis of variance (ANOVA). Results: The results indicated that both intervention groups produced significant improvements in psychological outcomes compared to the control group. Specifically, participants demonstrated increased distress tolerance and reduced self-blame (P < 0.001). Post-hoc analyses further revealed that CFT was significantly more effective than ST in reducing overall self-blame and its subcomponents, as well as in enhancing distress tolerance among People living with human immunodeficiency virus (PLWH, P < 0.05). Conclusions: Both interventions were effective in enhancing distress tolerance and reducing self-blame among PLWH. However, CFT demonstrated superior outcomes, suggesting that interventions explicitly designed to cultivate self-compassion may be particularly advantageous in addressing the distinct psychological challenges associated with this population. These findings underscore the potential value of integrating compassion-based approaches into psychosocial care for PLWH.